Archived: Dimensions 2 Farnham Road

This comprehensive inspection took place on 4 and 5 October 2018. The inspection was unannounced, which meant the staff and provider did not know we would be visiting.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm, neglect, abuse and discrimination by staff who understood their responsibilities to safeguard people. People were involved in managing their risks which were person-centred, proportionate and reviewed regularly. Restrictions were minimised so that people felt safe but also had the most freedom possible.

Medicines were administered safely, as prescribed by staff who had been assessed to be competent to do so.

Prospective staff underwent relevant pre-employment checks to ensure they were suitable to work with the people who lived with autism or a learning disability. There were always sufficient suitable staff with the right experience and skills mix, to provide care and support to meet people’s needs.

Staff effectively managed the control and prevention of infection within the service and adopted recognised safe preparation of food guidance.

The registered manager encouraged staff to raise concerns about incidents and near misses, so action could be taken to avoid further recurrence.

Staff were enabled to develop and maintain the necessary skills to meet people’s needs. People were supported to eat a healthy, balanced diet and had access to the food and drink of their choice, when they wanted it. People’s needs were assessed regularly, reviewed and updated.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Best interest decisions were consistently made in accordance with legislation to ensure people’s human and legal rights were respected.

People experienced consistency of care from regular staff who were kind and compassionate. There was a caring and positive atmosphere within the home, where people were relaxed and reassured by the presence of staff, whom they knew well.

Staff consistently treated people as individuals, with dignity and respect. Staff spoke with passion and pride about people’s achievements and their special qualities, which demonstrated how they valued them as individuals.

People were supported to take part in activities that they enjoyed. Staff supported people to maintain relationships with their families and those that mattered to them, and to develop new friendships, which protected them from the risk of social isolation.

People’s care plans were person centred and detailed how their assessed needs were to be supported by staff. People experienced care that was flexible and responsive to their individual needs, which enriched the quality of their lives and improved their physical and mental wellbeing.

Feedback consistently showed staff had an excellent understanding of individual’s social and cultural diversity, their values and beliefs, and how they wanted to receive their care and support. The service had received no complaints. However, people and their families were confident that if they did complain, they will be taken seriously, and their concern will be explored thoroughly and responded to effectively.

The service was well led by the registered manager, who consistently inspired staff to deliver high quality care. The provider’s values were clearly understood by all staff, which they demonstrated when supporting people. The quality of the support people received was effectively monitored and identified shortfalls were acted on to drive continuous improvement of the service.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were protected from abuse, because support workers understood the process to identify and report safeguarding concerns. People were supported to understand their rights and discuss any concerns related to abuse.

Risks associated with people’s care and support needs were identified and addressed to protect them from harm. Regular checks and servicing ensured environmental risks were managed safely.

Staffing levels were planned to support people’s needs and wishes safely. Short notice absence and lack of availability of agency cover had affected staffing levels over the Christmas period. The registered manager had reviewed all known risks, such as people’s health and wellbeing, and changed shift hours, to ensure people had not been placed at risk of harm by reduced staffing levels.

The provider’s recruitment procedures ensured people were protected from the risk of employing unsuitable staff to support them. All required checks had been completed to ensure successful applicants were suitable for the role of support worker.

People’s prescribed medicines were stored and disposed of safely. Support workers were trained and assessed to ensure they administered people’s medicines safely.

Regular training updates ensured people were supported by staff who could effectively meet their needs. Supervisory and appraisal meetings ensured support workers were encouraged to reflect on their care provision, and develop their skills and knowledge.

Support workers understood and implemented the principles of the Mental Capacity Act (MCA) 2005. They supported people to make informed decisions, and followed people’s wishes if they declined offered support. As appropriate, records demonstrated that a process of mental capacity assessment and best interest decisions promoted people’s safety and welfare when necessary.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Appropriate DoLS applications had been made on behalf of people following the completion of procedures under the MCA 2005.

People were supported to maintain a healthy balanced diet. Support workers understood people’s dietary preferences, and managed risks associated with eating effectively.

People were supported to attend regular health checks. Support workers recognised indicators that people were unwell or upset, and took appropriate actions to promote people’s health and wellbeing.

People’s relatives told us their loved ones were happy and content in the home. We observed people readily asked for support when they wanted this, and appeared relaxed with the support workers who cared them. Support workers valued people’s contribution in the home. They promoted people’s independence, and praised people when they undertook or completed household tasks.

People’s privacy and dignity were promoted through support workers’ actions to protect them from undignified situations.

People’s needs were assessed and regularly reviewed to ensure their care and support was responsive to changes identified. Support workers understood how people communicated, and were able to interpret gestures and vocalisations when people were unable to speak with them. Support plans and monthly reviews documented the support and care people required, and how this should be provided in accordance with their wishes.

The provider’s complaints policy explained how complaints should be managed. People’s relatives told us they had not had reason to use this, because good communication with and effective actions from support workers ensured any issues were addressed promptly before they escalated.

The provider’s aim to support people to live fulfilled lives was demonstrated by support workers who understood and promoted people’s wishes and independence. Support workers were supported to develop career aspirations to progress within the provider’s organisation.

The management structure in the home ensured support workers could access guidance and reassurance as needed. Support workers were confident in their roles.

Feedback from people and their relatives was sought to identify changes and improvements required to the quality of care people experienced. The provider’s audits and service improvement plan were used to review changes implemented, and ensure all required actions were in place to address improvements identified. Systems were in place to ensure people were supported in a service that was well-led and focussed on providing them with high quality care.

One member of staff told us "the people we support can communicate their wishes really well and if they do not want to do something they all have their ways of letting us know".

People chose how to occupy themselves in the service. We observed that people were spending time with staff watching television and listening to Christmas music. During our inspection we saw several people being supported by staff to access the community including one person who completed their christmas shopping and another person who attended the local day centre. Observation during the inspection showed staff supporting people to make their own choices about what they had for lunch.

People who use the service were allowed to decorate their rooms to their taste and had pictures and photos on the walls. All the rooms that we saw had ornaments and personal belongings on show.

Care plans were person centred and documented people's wishes in relation to how their care was provided. Staff members understood how people expressed their needs and wishes about how they wanted to be supported with their care. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

One person told us they took part in their chosen activities and they described what they enjoyed doing. This person told us they had their own menu that suited them and they felt safe in this home.

One other person communicated with us using signs and verbal sounds. They indicated they could make their own drinks and they could move freely around the home. One other person responded with nods when asked if they were comfortable.

We observed that the staff knew each person's individual communication needs and they used these to support people to make choices. We saw that the staff were putting into practice the recorded guidance from the care plans when they supported and cared for people.

Staff from the home or from other agencies were busy supporting people to access different community activities during the day.